Preoperative Ionized Magnesium Levels and Risk of Acute Kidney Injury After Cardiac Surgery

Koh, Hee Byung; Jung, Chan‐Young; Kim, Hyung Woo; Kwon, Jae Yeol; Kim, Na Hye; Kim, Hyo Jeong; Jhee, Jong Hyun; Han, Seung Hyeok; Yoo, Tae‐Hyun; Kang, Shin‐Wook; Park, Sun-Hee

doi:10.1053/j.ajkd.2022.03.004

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…A total of 53 patients, accounting for 54% of the study population, developed AKI following cardiac surgery. This finding aligns with our previous report (64% [ 20 ]), a recent report focused on the Korean population (40.1% [ 21 ]), as well as studies conducted on the MIMIC-III cohort (58% with severe stage 2 or 3 AKI [ 22 ]) and the eICU cohort (37% with severe stage 2 or 3 AKI [ 22 ]). In patients with AKI, the operation time was 281.6 ± 74.4 min, which was significantly longer than that in individuals without AKI (241.9 ± 44.9 min, P = 0.002).…”

Section: Resultssupporting

confidence: 92%

Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

Zhang,

Hou

et al. 2023

BMC Anesthesiol

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Background The association between tissue oxygenation with postoperative acute kidney injury (AKI) in adult patients undergoing multiple valve surgery has not been specifically studied. Methods In this prospective exploratory cohort study, 99 patients were enrolled. The left forehead, the left forearm, the left upper thigh, and the left renal region tissue oxygen saturation using near-infrared spectroscopy were monitored. The association between each threshold and AKI was assessed. The relative and absolute thresholds were < 70%, < 75%, < 80%, < 85%, < 90%, < 95%, and < 100% baseline, and baseline-standard deviation (SD), -1.5 SD, -2 SD, -2.5 SD, and -3 SD. Multivariate logistic regression analysis was adopted to explore the association. Results AKI occurred in 53 (54%) patients. The absolute value-based SrrO2 thresholds associated with AKI were baseline-3 SD (odds ratio [OR], 4.629; 95% confidence interval [CI], 1.238–17.314; P = 0.023) and baseline-2.5 SD (OR, 2.842; 95% CI, 1.025–7.881; P = 0.045) after adjusting for the potential confounders, those are renal region tissue oxygen saturation of 55% and 60%, but not statistically significant after correcting for multiple testing (corrected P = 0.114 and 0.179, respectively). Conclusion The SrrO2 desaturation, defined as < baseline – 2.5 SD or < baseline – 3 SD, may be associated with AKI. The thresholds need to be verified in future large-scale studies. Trial registrations The study was registered at ClinicalTrials.gov, first trial registration: 26/10/2017, identifier: NCT03323203.

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Section: Resultssupporting

confidence: 92%

Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

Zhang,

Hou

et al. 2023

BMC Anesthesiol

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“…In contrast, hypermagnesemia did not show a significant association with AKI onset or lower non-recovery rates, defined as maintenance of the same or a higher AKI stage [ 125 ]. These outcomes have been consistently demonstrated by Koh et al [ 126 ], in a retrospective observational cohort study on 9766 patients after cardiac surgery. The study showed a progressively increased prevalence of AKI with lower magnesium levels.…”

Section: Discussionsupporting

confidence: 65%

Role of Magnesium in the Intensive Care Unit and Immunomodulation: A Literature Review

et al. 2023

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Both the role and the importance of magnesium in clinical practice have grown considerably in recent years. Emerging evidence suggests an association between loss of magnesium homeostasis and increased mortality in the critical care setting. The underlying mechanism is still unclear, but an increasing number of in vivo and in vitro studies on magnesium’s immunomodulating capabilities may shed some light on the matter. This review aims to discuss the evidence behind magnesium homeostasis in critically ill patients, and its link with intensive care unit mortality via a likely magnesium-induced dysregulation of the immune response. The underlying pathogenetic mechanisms, and their implications for clinical outcomes, are discussed. The available evidence strongly supports the crucial role of magnesium in immune system regulation and inflammatory response. The loss of magnesium homeostasis has been associated with an elevated risk of bacterial infections, exacerbated sepsis progression, and detrimental effects on the cardiac, respiratory, neurological, and renal systems, ultimately leading to increased mortality. However, magnesium supplementation has been shown to be beneficial in these conditions, highlighting the importance of maintaining adequate magnesium levels in the intensive care setting.

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“…The data above indicate that serum magnesium holds a relatively limited predictive value when used as a single biomarker for AKI after TAAR. Interestingly, researchers discovered that the incidence of AKI was related to decrease serum magnesium levels both preoperatively and intraoperatively, and patients who received magnesium supplementation had a lower risk of AKI (39,40). Researchers have suggested that decreased magnesium levels have been linked to increased levels of both proatherogenic and inflammatory cytokines in endothelial cells, affecting renal function (41,42).…”

Section: Discussionmentioning

confidence: 99%

The role of serum magnesium in the prediction of acute kidney injury after total aortic arch replacement: A prospective observational study

Jiang,

Li,

Pan

et al. 2024

J Med Biochemistry

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Background: Considerable morbidity and death are associated with acute kidney damage (AKI) following total aortic arch replacement (TAAR). The relationship between AKI following TAAR and serum magnesium levels remains unknown. The intention of this research was to access the predictive value of serum magnesium levels on admission to the Cardiovascular Surgical Intensive Care Unit (CSICU) for AKI in patients receiving TAAR. Methods: From May 2018 to January 2020, a prospective, observational study was performed in the Guangdong Provincial People's Hospital CSICU. Patients accepting TAAR admitted to the CSICU were studied. The Kidney Disease: Improving Global Outcomes (KDIGO) definition of serum creatinine was used to define AKI, and KDIGO stages two or three were used to characterize severe AKI. Multivariable logistic regression and area under the curve receiver-operator characteristic curve (AUC-ROC) analysis were conducted to assess the predictive capability of the serum magnesium for AKI detection. Finally, the prediction model for AKI was established and internally validated. Results: Of the 396 enrolled patients, AKI occurred in 315 (79.5%) patients, including 154 (38.8%) patients with severe AKI. Serum magnesium levels were independently related to the postoperative AKI and severe AKI (both, P < 0.001), and AUC-ROCs for predicting AKI and severe AKI were 0.707 and 0.695, respectively. Across increasing quartiles of serum magnesium, the multivariable-adjusted odds ratios (95% confidence intervals) of postoperative AKI were 1.00 (reference), 1.04 (0.50-2.82), 1.20 (0.56-2.56), and 6.19 (2.02-23.91) (P for Trend < 0.001). When serum magnesium was included to a baseline model with established risk factors, AUC-ROC (0.833 vs 0.808, P = 0.050), reclassification (P < 0.001), and discrimination (P = 0.002) were further improved. Conclusion: Serum magnesium levels on admission are an independent predictor of AKI. In TAAR patients, elevated serum magnesium levels were linked to an increased risk of AKI. In addition, the established risk factor model for AKI can be considerably improved by the addition of serum magnesium in TAAR patients hospitalized in the CSICU.

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Preoperative Ionized Magnesium Levels and Risk of Acute Kidney Injury After Cardiac Surgery

Cited by 10 publications

References 39 publications

Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

Role of Magnesium in the Intensive Care Unit and Immunomodulation: A Literature Review

The role of serum magnesium in the prediction of acute kidney injury after total aortic arch replacement: A prospective observational study

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